Shift from
Volume to Value

Health plans and providers are moving beyond analytics-driven pilots to full-scale operational value-based reimbursement (VBR) programs. Critical to this shift, is the alignment of financial and clinical data, administrative and contract automation, as well as transparency to control costs.

35% of all reimbursement will be value-based in the next 36 months1

MSSP programs to grow to 7.2 million lives in 20152

Over 50% of VBR contracts in the next 36 months will have downside risk3

Our goal is to have 85% of all Medicare fee-for-service payments tied to quality or value by 2016, and 90% by 2018.

Volume to Value Maturity Model

Lessons Learned from the Road to Value and Savings

An ambitious regional Blue Cross Blue Shield plan needed to embark on a major multi-component strategic initiative. This initiative consisted of achieving specific medical loss and administrative loss ratio goals—as well as compliance with new market laws.

A Clear Path Forward: Paving the Way to Value-Based Reimbursement

In today’s healthcare industry, both payers and providers are experimenting with strategies to adopt value-based reimbursement (VBR), such as Shared Savings, Episodes of Care, and Pay-For-Performance. These policies fundamentally redefine the boundaries and roles of health plans, providers and members.

A Clear Path Forward: Paving the Way to Value-Based Partnership

Value-based reimbursement methodologies, like Bundled Payments and Shared Savings, are taking a firm hold on the managed care and commercial markets. If these initiatives are to deliver on the “increased quality with lower costs” promise, then new types of partnerships must evolve between health plans, providers, members and employer groups.